Provider Demographics
NPI:1902168800
Name:CHILDREN'S HOSPITAL MEDICAL CENTER
Entity type:Organization
Organization Name:CHILDREN'S HOSPITAL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR DIRECTOR BILLING & CODING SR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOMALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-636-5047
Mailing Address - Street 1:3333 BURNET AVENUE
Mailing Address - Street 2:MAIL LOCATION 5021
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3039
Mailing Address - Country:US
Mailing Address - Phone:513-636-4225
Mailing Address - Fax:513-636-2511
Practice Address - Street 1:5642 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-3114
Practice Address - Country:US
Practice Address - Phone:513-636-4225
Practice Address - Fax:513-636-2511
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HOSPITAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-15
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2871576Medicaid